腰硬联合麻醉与硬膜外麻醉在高龄产妇剖宫产术中的应用效果比较

Comparison of the application effects of combined spinal and epidural anesthesia and epidural anesthesia in cesarean section of elderly parturients

目的比较腰硬联合麻醉与硬膜外麻醉在高龄产妇剖宫产术中的应用效果。方法选取2017年9月至2019年9月我院收治的64例行剖宫产术的高龄产妇为研究对象,根据随机数字表法将其分为腰硬联合组(n=32,腰硬联合麻醉)与硬膜外组(n=32,硬膜外麻醉)。比较两组的麻醉效果。结果腰硬联合组的麻醉效果Ⅰ级占比高于硬膜外组,Ⅳ级占比低于硬膜外组(P<0.05)。腰硬联合组的运动阻滞起效时间、感觉阻滞起效时间、运动阻滞完善时间、感觉阻滞完善时间均短于硬膜外组(P<0.05)。切皮时(T_(2))、胎儿娩出时(T_(3)),腰硬联合组的收缩压(SBP)高于硬膜外组(P<0.05);感觉阻滞平面固定(T_(1))、T_(2)、T_(3)时,腰硬联合组的舒张压(DBP)高于硬膜外组(P<0.05);T_(1)、T_(2)时,腰硬联合组的心率(HR)低于硬膜外组(P<0.05)。手术后,腰硬联合组的血清皮质醇(COR)、促肾上腺皮质激素(ACTH)、醛固酮(ALD)、血管紧张素Ⅱ(AngⅡ)、肾素(R)水平均低于硬膜外组(P<0.05)。结论与硬膜外麻醉相比,腰硬联合麻醉用于高龄产妇剖宫产术中的效果更加理想。

Objective To compare the application effects of combined spinal and epidural anesthesia and epidural anesthesia in cesarean section of elderly parturients.Methods Sixty-four elderly parturients who underwent cesarean section in our hospital from September 2017 to September 2019 were selected as the study objects and divided into combined spinal and epidural group(n=32,combined spinal and epidural anesthesia)and epidural group(n=32,epidural anesthesia)according to random number table method.The anesthetic effects of the two groups were compared.Results The proportion of gradeⅠof anesthetic effect in the combined spinal and epidural group was higher than that in the epidural group,and the proportion of gradeⅣwas lower than that in the epidural group(P<0.05).The onset time of motor block,onset time of sensory block,completion time of motor block and completion time of sensory block in the combined spinal and epidural group were shorter than those in the epidural group(P<0.05).At skin incision(T_(2))and fetal delivery(T_(3)),the systolic blood pressure(SBP)in the combined spinal and epidural group was higher than that in the epidural group(P<0.05);at the sensory block plane was fixed(T_(1)),T_(2),and T_(3),the diastolic blood pressure(DBP)of the combined spinal and epidural group was higher than that of the epidural group(P<0.05);at T_(1) and T_(2),the heart rate(HR)of the combined spinal and epidural group was lower than that of the epidural group(P<0.05).After operation,the levels of serum cortisol(COR),adrenocorticotropic hormone(ACTH),aldosterone(ALD),angiotensinⅡ(AngⅡ)and renin(R)in the combined spinal and epidural group were lower than those in the epidural group(P<0.05).Conclusion Compared with epidural anesthesia,combined spinal and epidural anesthesia has a more ideal effect on cesarean section of elderly parturients.